During our previous study of patients with ovarian cancer, we observed a high prevalence of pain, fatigue, and psychological distress among those with persistent disease and noted the existence of a stereotypical pain syndrome that heralded disease onset in a majority of patients. In this application, we propose studies that evaluate novel management strategies for each of these major symptoms and attempt to determine the importance of this newly described pain syndrome. The abdominal pain associated with malignant bowel obstruction is a challenging problem that may not respond satisfactorily to opioid therapy. Despite a lack of data from controlled studies, anticholinergic drugs are now used empirically as adjuvant analgesics in this setting. Study 1 of this proposal is a placebo-controlled, parallel-group, repeated-dose comparison of scopolamine and glycopyrrolate, two commercially available anticholinergic drugs that may differ in side effects due to variable penetrance of the blood-brain barrier. Cancer- related fatigue also never been studied in controlled fashion, despite its very high prevalence. We propose two controlled trials that will be the first to evaluate the safety and efficacy of psychostimulated drugs for this condition. Study 2 is a placebo-controlled, repeated-dose, parallel-group efficacy trial of the psychostimulant methylphenidate; and Study 3 is a placebo-controlled, repeated-dose, parallel-group comparison of methylphenidate and the novel psychostimulant pemoline. The latter drug may be particularly useful in the ovarian cancer population due to the availability of a chewable formulation and a side-effect profile that may be better than other stimulants. Given the high prevalence and adverse impact of pain and psychological distress in the ovarian cancer population, new approaches are needed for the long-term management of these problems. In the Study 4, we proposed a randomized trial that will evaluate the utility of a prospective telephone screening program, which has been designed to identify and provide early intervention for those patients with active ovarian cancer who experience unrelieved pain or heightened psychological distress. Finally, we propose to replicate and further define our previous findings that a stereotypical pain syndrome may herald the onset of disease in those who achieve remission following primary therapy. Study 5 is a prospective longitudinal survey of this subpopulation, which will additionally provide information about the potential of pain monitoring as a means of improving early diagnosis. The information acquired through these studies will have important implications for the supportive care of patients with ovarian cancer.